脑卒中患者膈肌功能评估与康复干预临床研究
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摘要
目的:评估脑卒中患者膈肌功能,探讨体外膈肌起搏对脑卒中患者呼吸功能、膈肌厚度、活动度及肺功能的影响,为体外膈肌起搏的教学研究和临床应用提供思路。方法:选取2017年12月—2018年3月南京市江宁医院康复科住院脑卒中患者20例作为脑卒中组;另招募与脑卒中组性别、年龄相匹配的健康志愿者20例作为健康对照组。脑卒中组患者接受2周体外膈肌起搏治疗,健康对照组不予处理。收集并比较2组膈肌起搏治疗前后不同呼吸时相(平静呼吸、深吸气)膈肌厚度、膈肌厚度比、膈肌位移、肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV_1)]、血气分析指标[pH、血二氧化碳分压(PaCO_2)、血氧分压(PaO_2)、血氧饱和度(SaO_2)、氧和指数(PaO_2/FiO_2)]各项数值及疲劳严重程度量表(FSS)评分。结果:治疗前脑卒中组膈肌厚度比、膈肌位移、FVC、FEV_1、FEV_1/FVC、PaO_2/FiO_2、SaO_2明显低于健康对照组(P<0.05);脑卒中组pH值、疲劳指数明显高于健康对照组(P<0.05)。体外膈肌起搏治疗后,脑卒中组膈肌厚度比、深吸气后膈肌位移、FVC、FEV_1、FEV_1/FVC、氧和指数、SaO_2较治疗前明显提高(P<0.05);脑卒中组pH值、疲劳指数较治疗前明显下降(P<0.05)。结论:脑卒中患者膈肌增厚比、膈肌位移、肺功能明显低于正常人,使用体外膈肌起搏治疗后,患者呼吸功能得到改善,脑卒中后疲劳缓解。
Objective: To evaluate the diaphragm function of stroke patients and investigate the effect of an external diaphragm pacemaker(EDP) on post-stroke respiratory function. Methods: Included in this study were twenty patients after stroke in Rehabilitation Department of Nanjing Jiangning Hospital during December 2017 to March 2018, and they were selected as the experimental group. Twenty healthy volunteers as the control group matched with the gender and age. Stroke patients in the experimental group were enrolled for two weeks of external diaphragmatic pacing treatment. Before and after two weeks of treatment, both groups were evaluated using the mean values of normal for thick and motion of the right hemidiaphragms during quiet breathing and deep breathing, pulmonary function tests, including forced vital capacity(FVC) and forced expiratory volume in one second(FEV_1), arterial blood gas analysis(arterial partial pressure of oxygen PaO_2, oxygenation index, partial pressure of carbon dioxide PaCO_2, pH value) and a fatigue severity scale(FSS). Results: The ratio of diaphragm thickness, diaphragm displacement, forced vital capacity, FEV_1, FEV_1/FVC,oxygen and index, and SaO_2 in the experimental group were significantly lower than those of the control group, pH value and fatigue index in the experimental group were significantly higher than those of the control group. The diaphragm muscle thickness ratio, diaphragmatic displacement, forced vital capacity, the FEV_1, FEV_1/FVC, oxygen and index, and SaO_2 were significantly higher after EDP, and the pH value and fatigue index were lower after EDP, and all had statistically significant differences. Conclusion: Diaphragm function and lung function are significantly reduced after stroke, and external diaphragm pacemaker treatment plays a role in helping to improve respiratory function and relieve fatigue after stroke.
Objective: To evaluate the diaphragm function of stroke patients and investigate the effect of an external diaphragm pacemaker(EDP) on post-stroke respiratory function. Methods: Included in this study were twenty patients after stroke in Rehabilitation Department of Nanjing Jiangning Hospital during December 2017 to March 2018, and they were selected as the experimental group. Twenty healthy volunteers as the control group matched with the gender and age. Stroke patients in the experimental group were enrolled for two weeks of external diaphragmatic pacing treatment. Before and after two weeks of treatment, both groups were evaluated using the mean values of normal for thick and motion of the right hemidiaphragms during quiet breathing and deep breathing, pulmonary function tests, including forced vital capacity(FVC) and forced expiratory volume in one second(FEV_1), arterial blood gas analysis(arterial partial pressure of oxygen PaO_2, oxygenation index, partial pressure of carbon dioxide PaCO_2, pH value) and a fatigue severity scale(FSS). Results: The ratio of diaphragm thickness, diaphragm displacement, forced vital capacity, FEV_1, FEV_1/FVC,oxygen and index, and SaO_2 in the experimental group were significantly lower than those of the control group, pH value and fatigue index in the experimental group were significantly higher than those of the control group. The diaphragm muscle thickness ratio, diaphragmatic displacement, forced vital capacity, the FEV_1, FEV_1/FVC, oxygen and index, and SaO_2 were significantly higher after EDP, and the pH value and fatigue index were lower after EDP, and all had statistically significant differences. Conclusion: Diaphragm function and lung function are significantly reduced after stroke, and external diaphragm pacemaker treatment plays a role in helping to improve respiratory function and relieve fatigue after stroke.
引文
[1] GBD 2013 MORTALITY AND CAUSES OF DEATH COLLABORATORS. Global,regional,and national age-sex specific allcause and cause-specific mortality for 240 causes of death,1990-2013:A systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet,2015,385(9963):117-171.
[2]阻塞性睡眠呼吸暂停与卒中诊治专家共识组.阻塞性睡眠呼吸暂停与卒中诊治专家共识[J].中华内科杂志,2014,53(8):657-664.
[3]李琳琳,郝世杰,王万宏,等.膈肌松解技术联合吸气肌训练对脑卒中患者肺功能的影响[J].康复学报,2018,28(1):19-23.
[4]田野,胡可慧,杨欢,等.呼吸肌训练联合肌电生物反馈训练对脑卒中后吞咽功能及吸入性肺炎的影响[J].康复学报,2018,28(1):41-44.
[5]黄岳,崔利华,刘丽旭,等.脑卒中患者的呼吸功能障碍及其康复[J].中国康复理论与实践,2015,21(9):1055-1057.
[6] REYNOLDS S C,MEYYAPPAN R,THAKKAR V,et al. Mitigation of ventilator-induced diaphragm atrophy by transvenous phrenic nerve stimulation[J]. Am J Respir Crit Care Med,2017,195(3):339-348.
[7]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-388.
[8]马艳,王小云,岳翔,等.膈肌训练对脑卒中后疲劳患者日常生活活动的影响[J].中华物理医学与康复杂志,2016,38(8):587-590.
[9] DAVIS R T3RD,BRUELLS C S,STABLEY J N,et al. Mechanical ventilation reduces rat diaphragm blood flow and impairs oxygen delivery and uptake[J]. Crit Care Med,2012,40(2):2858-2866.
[10] BROGAN E,LANGDON C,BROOKES K,et al. Respiratory infections in acute stroke:nasogastric tubes and immobility are stronger predictors than dysphagia[J]. Dysphagia,2014,29(3):340-345.
[11] KIM M,LEE K,CHO J,et al. Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients[J]. Medical science monitor:international medical journal of Experimental and clinical research,2017,23(12):1247-1253.
[12] PINHEIRO M B,POLESE J C,FARIA C D,et al. Inspiratory muscular weakness is most evident in chronic stroke survivors with lower walking speeds[J]. Eur J Phys Rehabil Med,2014,50(13):301-307.
[13] LEE K B,KIM M K,LEE W H. Reliability of an electronic inspiratory loading device for assessing pulmonary function in post-stroke patients[J]. Med Sci Monit,2016,22(4):191-196.
[14] REYNOLDS S C,MEYYAPPAN R,THAKKAR V,et al. Mitigation of ventilator-induce diaphragm atrophy by transvenous phrenic nerve stimulation[J]. Am J Respir Crit Care Med,2017,195(3):339-348.
[15] AHN B,BEAVER T,MARTIN T,et al. Phrenic nerve stimulation increases human diaphragm fiber force after cardiothoracic surgery[J]. Am J Respir Crit Care Med,2014,190(7):837-839.
[2]阻塞性睡眠呼吸暂停与卒中诊治专家共识组.阻塞性睡眠呼吸暂停与卒中诊治专家共识[J].中华内科杂志,2014,53(8):657-664.
[3]李琳琳,郝世杰,王万宏,等.膈肌松解技术联合吸气肌训练对脑卒中患者肺功能的影响[J].康复学报,2018,28(1):19-23.
[4]田野,胡可慧,杨欢,等.呼吸肌训练联合肌电生物反馈训练对脑卒中后吞咽功能及吸入性肺炎的影响[J].康复学报,2018,28(1):41-44.
[5]黄岳,崔利华,刘丽旭,等.脑卒中患者的呼吸功能障碍及其康复[J].中国康复理论与实践,2015,21(9):1055-1057.
[6] REYNOLDS S C,MEYYAPPAN R,THAKKAR V,et al. Mitigation of ventilator-induced diaphragm atrophy by transvenous phrenic nerve stimulation[J]. Am J Respir Crit Care Med,2017,195(3):339-348.
[7]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-388.
[8]马艳,王小云,岳翔,等.膈肌训练对脑卒中后疲劳患者日常生活活动的影响[J].中华物理医学与康复杂志,2016,38(8):587-590.
[9] DAVIS R T3RD,BRUELLS C S,STABLEY J N,et al. Mechanical ventilation reduces rat diaphragm blood flow and impairs oxygen delivery and uptake[J]. Crit Care Med,2012,40(2):2858-2866.
[10] BROGAN E,LANGDON C,BROOKES K,et al. Respiratory infections in acute stroke:nasogastric tubes and immobility are stronger predictors than dysphagia[J]. Dysphagia,2014,29(3):340-345.
[11] KIM M,LEE K,CHO J,et al. Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients[J]. Medical science monitor:international medical journal of Experimental and clinical research,2017,23(12):1247-1253.
[12] PINHEIRO M B,POLESE J C,FARIA C D,et al. Inspiratory muscular weakness is most evident in chronic stroke survivors with lower walking speeds[J]. Eur J Phys Rehabil Med,2014,50(13):301-307.
[13] LEE K B,KIM M K,LEE W H. Reliability of an electronic inspiratory loading device for assessing pulmonary function in post-stroke patients[J]. Med Sci Monit,2016,22(4):191-196.
[14] REYNOLDS S C,MEYYAPPAN R,THAKKAR V,et al. Mitigation of ventilator-induce diaphragm atrophy by transvenous phrenic nerve stimulation[J]. Am J Respir Crit Care Med,2017,195(3):339-348.
[15] AHN B,BEAVER T,MARTIN T,et al. Phrenic nerve stimulation increases human diaphragm fiber force after cardiothoracic surgery[J]. Am J Respir Crit Care Med,2014,190(7):837-839.